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Experimental development of a living skin equivalent
Abstracts
451
had had a prior history of osteomylitis, went on to solid bone union. The author commented that the rate of union achieved was similar to that reported with bone-grafting procedures, but felt that it was a safe method and he had no mortality or significant morbidity in his series. Brighton C. T. (1981) Treatment of non-union of the tibia with constant direct current. J. Trauma 21, 188.
This provided sufficient protective sensation to allow the patient to return to manual labour without skin breakdown. This supraclavicular pedicle flap is large, and provides three or sometimes more, donor nerves, for reconstruction of multiple injured digits. Sommerlad 9. C. and Boorman J. G. (198 1) Innervated supraclavicular flap for reconstruction of major hand injuries. Hand 13,5.
Experimental equivalent
Sensation in cross-fmger flaps
d&elopment
of
a
living
skin
This unit has developed a living skin equivalent which served as a skin substitute in experimental animals. On application it was rapidly vascularized inhibiting wound contracture and was immunologically tolerated and persisted for as long as it was allowed to remain in place. It came to resemble normal skin, although it lacked hair follicles and sweat glands, cells of the latter may in time be available for incorporation into the fabricated tissue. Bell E., Ehrlich H. P., Sher S. et al. (1981) Development and use ofa living skin equivalent. P/as. Reconstr. Surg. 67,386. Organization tion
topics
and
accident
preven-
Fifty-one patients who had received cross-finger flaps l-6 years previously were re-examined, to assess the time and the degree of recovery of sensation in the injured finger-tips. The difference in millimetres between the 2-point discrimination distance in the transferred flap, and in the same area on the same finger ofthe other hand, was measured. It was found that recoverv was maximal within a year of the operation, and that a difference in 2-point d’iscrimination of 2 mm or less, was observed in 26 (53 per cent) of49 patients in whom the tests were reliable. The results were best in patients who were less than 20 years old. Nicolai J. P. A. and Hentenaar Cl. (198 I) Sensation in cross-finger flaps. Hand 13, 12.
Silastic foam dressing
Fractures and dislocations
Silastic foam was easier and cheaper to use and less painful for the patient than a moistened gauze pack but was not associated with any quicker healing of the wounds. Williams R. H. P., Wood R. A. B., Mason M. C. et al. (I 98 1) Multicentre prospective trial of Silastic foam dressing in management of open granulatory wounds. Br. Med. J. 282.2 I
General side plates
Falls by old people at home
Falls by old persons at home are usually a result of their poor health rather than external hazards. Those at risk are over 75 years, housebound, unsteady and fearful of falling. Of 125 persons over 65 years who fell at home, most suffered trivial injuries but 3 broke their femur and 15 other bones. Twenty lay on the floor for more than an hour. None became hypothermic. A quarter were dead within a year, which is five times the proportion found in a suitably matched control group. Wild D., Nayak U. S. L., Issacs 9. et al. (198 I) How dangerous are falls in old people at home? Br. Med. J. 282,266. Hand injuries Supraclavicular pedicle flap
Following anatomical studies of the numbers and distribution of the supraclavicular nerves, the authors employed an innervated flap to cover the stumps of three degloved fingers. They employed three supraclavicular branches, which were sutured to the appropriate digital nerves, using an operating microscope.
The author had noted the varying lengths of plates used for the internal fixation of subtrochanteric and supracondylar fractures of the femur. He noted experimental evidence suggesting that 4,6 or 8 cortices gave adequate fixation. In his series of 56 patients, 27 of them had had the femoral shaft fixed by using more than 10 cortices. He felt that in these cases the fixation was excessive requiring excessive dissection, greater blood loss with a greater risk of infection. Conversely fractures secured with 5 cortices or less were likely to become insecure. Seinsheimer F. III (1981) Concerning the proper length ofgeneral side plates. J. Trauma 21,42. Ankles injured by inversion
Ankles injured by inversion were examined clinically and then radiologically. Of 241 patients, 85 per cent had sprains and 2.5 per cent had more serious tears of the lateral ligament; 12.5 per cent had fractures. Five per cent of the fractures were not recognized during clinical examination, but they were all treatable as sprains. The authors emphasize and describe the care needed in both taking the history and examining the part before deciding to dispense with the use of radiographs. Serious tears of the lateral ligament were diagnosed by testing for more than 15” tilting of the talus by forced inversion aided by entonox within 3 days of injury. Brooks S. C., Potter 9. T. and Rainey J. 9. (198 1) Inversion injuries of the ankle: clinical assessment and radiographic review. Br. Med. J. 282,607.
451
had had a prior history of osteomylitis, went on to solid bone union. The author commented that the rate of union achieved was similar to that reported with bone-grafting procedures, but felt that it was a safe method and he had no mortality or significant morbidity in his series. Brighton C. T. (1981) Treatment of non-union of the tibia with constant direct current. J. Trauma 21, 188.
This provided sufficient protective sensation to allow the patient to return to manual labour without skin breakdown. This supraclavicular pedicle flap is large, and provides three or sometimes more, donor nerves, for reconstruction of multiple injured digits. Sommerlad 9. C. and Boorman J. G. (198 1) Innervated supraclavicular flap for reconstruction of major hand injuries. Hand 13,5.
Experimental equivalent
Sensation in cross-fmger flaps
d&elopment
of
a
living
skin
This unit has developed a living skin equivalent which served as a skin substitute in experimental animals. On application it was rapidly vascularized inhibiting wound contracture and was immunologically tolerated and persisted for as long as it was allowed to remain in place. It came to resemble normal skin, although it lacked hair follicles and sweat glands, cells of the latter may in time be available for incorporation into the fabricated tissue. Bell E., Ehrlich H. P., Sher S. et al. (1981) Development and use ofa living skin equivalent. P/as. Reconstr. Surg. 67,386. Organization tion
topics
and
accident
preven-
Fifty-one patients who had received cross-finger flaps l-6 years previously were re-examined, to assess the time and the degree of recovery of sensation in the injured finger-tips. The difference in millimetres between the 2-point discrimination distance in the transferred flap, and in the same area on the same finger ofthe other hand, was measured. It was found that recoverv was maximal within a year of the operation, and that a difference in 2-point d’iscrimination of 2 mm or less, was observed in 26 (53 per cent) of49 patients in whom the tests were reliable. The results were best in patients who were less than 20 years old. Nicolai J. P. A. and Hentenaar Cl. (198 I) Sensation in cross-finger flaps. Hand 13, 12.
Silastic foam dressing
Fractures and dislocations
Silastic foam was easier and cheaper to use and less painful for the patient than a moistened gauze pack but was not associated with any quicker healing of the wounds. Williams R. H. P., Wood R. A. B., Mason M. C. et al. (I 98 1) Multicentre prospective trial of Silastic foam dressing in management of open granulatory wounds. Br. Med. J. 282.2 I
General side plates
Falls by old people at home
Falls by old persons at home are usually a result of their poor health rather than external hazards. Those at risk are over 75 years, housebound, unsteady and fearful of falling. Of 125 persons over 65 years who fell at home, most suffered trivial injuries but 3 broke their femur and 15 other bones. Twenty lay on the floor for more than an hour. None became hypothermic. A quarter were dead within a year, which is five times the proportion found in a suitably matched control group. Wild D., Nayak U. S. L., Issacs 9. et al. (198 I) How dangerous are falls in old people at home? Br. Med. J. 282,266. Hand injuries Supraclavicular pedicle flap
Following anatomical studies of the numbers and distribution of the supraclavicular nerves, the authors employed an innervated flap to cover the stumps of three degloved fingers. They employed three supraclavicular branches, which were sutured to the appropriate digital nerves, using an operating microscope.
The author had noted the varying lengths of plates used for the internal fixation of subtrochanteric and supracondylar fractures of the femur. He noted experimental evidence suggesting that 4,6 or 8 cortices gave adequate fixation. In his series of 56 patients, 27 of them had had the femoral shaft fixed by using more than 10 cortices. He felt that in these cases the fixation was excessive requiring excessive dissection, greater blood loss with a greater risk of infection. Conversely fractures secured with 5 cortices or less were likely to become insecure. Seinsheimer F. III (1981) Concerning the proper length ofgeneral side plates. J. Trauma 21,42. Ankles injured by inversion
Ankles injured by inversion were examined clinically and then radiologically. Of 241 patients, 85 per cent had sprains and 2.5 per cent had more serious tears of the lateral ligament; 12.5 per cent had fractures. Five per cent of the fractures were not recognized during clinical examination, but they were all treatable as sprains. The authors emphasize and describe the care needed in both taking the history and examining the part before deciding to dispense with the use of radiographs. Serious tears of the lateral ligament were diagnosed by testing for more than 15” tilting of the talus by forced inversion aided by entonox within 3 days of injury. Brooks S. C., Potter 9. T. and Rainey J. 9. (198 1) Inversion injuries of the ankle: clinical assessment and radiographic review. Br. Med. J. 282,607.